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CarePoint Therapy Management Blog

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Therapy Treatment Day Properly Defined: Don’t Miss Available RUG’s Levels!

Activity Edit Listing - Medicare Part A

A contract therapy client in Boston asked the following question … CarePoint included only 3 days of PT treatments in one patient’s RUG’s level calculation even though 4 days of PT treatments were provided.  Only 10 minutes of PT treatment were provided on one of those 4 days.  Treatments greater than 8 minutes are counted as one unit but I am not sure if this has anything to do with why only 3 days of PT treatment were included in the RUG’s level calculation.  Please explain why this is happening?  I want to make sure that all future RUG’s levels calculations are correct in CarePoint.

CarePoint Therapy Management Software Version 9.0 Is Now Available!

Medicare Part A - Clinical Activity Monitor

CarePoint Version 9.0 is now available and includes scores of new features that will improve quality control, ensure compliance, maximize reimbursements, and reduce administrative costs.  Selected new features and functions are listed below along with some sample reports.  Some highlights include …

Combined Assessments Can Maximize Medicare Part A Reimbursements

COT OMRA Management Report   Blog Aug. 8th 2012

Combining scheduled and unscheduled assessments require the application of complex rules and effective systems to monitor the regular assessment schedule and the “rolling” COT 7 day look back periods simultaneously.  The extra effort required can pay off in greater Medicare Part A reimbursements if you have the tools necessary to manage the process.

Therapy Session Minute Compliance: Know the Rules & Prevent Denials

concurrent therapy minutes - group therapy minutes - cms minute rules

Therapists are responsible for compliance with CMS rules pertaining to how different types of therapy minutes are provided during a treatment session.  If these rules are not applied correctly, the compliance errors that occur will result in denials.  These errors are costly both in terms of lost revenue and the time needed to research, re-bill, and recover that lost revenue.  The three different types of therapy minutes are individual, concurrent, and group therapy minutes.  Simple and effective tools are required to alert therapists when therapy minutes provided are not in compliance with CMS’s rules.  Better still, quick and easy ways that correct these errors before claims are submitted or RUG’s levels and ARD’s are selected will prevent denials and maximize reimbursements.

Managing EOT OMRA’s: Tools for Therapy Providers


CMS has issued the following guidelines for End of Therapy OMRA’s.
“An End of Therapy (EOT) OMRA would require a change in the RUG’s level for selected days.  An EOT OMRA is required if there are 3 missed days with no therapy from any discipline.  For the EOT OMRA followed by a SOT OMRA, the 3 or more missed days are billed at the NC RUG’s level.”  

Med A UB-04 Claim Form Change Update: Removal of Occurrence Code 16

Medicare Part A ub04 - Change Request 7717 - Occurence Code 16Reporting Requirement for CR 7717
Change Request 7717 states that CMS is discontinuing the requirement for Skilled Nursing Facility (“SNF”) and Swing Bed (“SB”) providers to report Occurrence Code 16 to indicate the last day of therapy services.  This change is effective with the release of Change Request 7717.
The skilled nursing facility (“SNF”) Open Door Forum reviewed various billing issues included in Change Request 7339 that were implemented on August 1, 2011.  Previous guidance was to …
Place the "End of Therapy" date in the Occurrence Code 16 field which is the day after all disciplines are complete.
Occurrence Code 16 is used only when an End of Therapy (“EOT”) OMRA is completed.  The EOT OMRA is done the day after the last therapy has ended.  The MDS coordinator has 3 days to complete the EOT OMRA but Occurrence Code 16 would indicate the actual last date of a therapy RUG’s level.  This reporting requirement has now been discontinued.
Additional Information
Our Director of Clinical Services monitors these issues closely for our clients.  We work closely with our clients on how to best address these types of billing and compliance issues.  CarePoint therapy management software works with more than 30 SNF billing and MDS software systems. 
The official instruction, CR 7717, issued to your FI or A/B MAC regarding this change may be viewed by clicking on the image above.
Contact your FI or A/B MAC at their toll-free number with any questions, which may be found at on the CMS website.

Therapy Day Requirements for a RUG’s Level Medium

Therapy Billing - RUG levels - CMS Compliance

CarePoint therapy management software strives for complete regulatory and compliance accuracy. Our system requires 5 calendar days of therapy in the last 7 days in order to achieve a RUG’s Level Medium (RM) in accordance with the PPS regulations of 1998. We understand all the discipline requirements for each RUG’s level.

Therapy Compliance Strategies: The Required 10th Visit Rule

Therapy 10th Visit Rule - Therapy EMR - Clinical Documentation - CMS - Therapy Compliance

Author: Mary L. Gennerman, OTR/L - Director of Clinical Services
Licensed therapists, typically an RPT or OTR, must be actively involved in a patient’s care at least once every 10th visit in order to verify that the therapy provided is consistent with the plan of care, to modify the plan of care if necessary, and to ensure that ongoing therapy is properly supervised.  Reliance on therapy assistants, typically LPTA’s or COTA’s, to treat patients for 10 visits or more will result in claims denials.  Providers often question whether the Required 10th Therapy Visit Rule applies to Medicare Part B patients only or to both Medicare Part A and B patients alike.

RUG’s Level OMRA’s: Know the Rules & Maximize Revenue

Medicare Part A - Therapy Billing - OMRA - RUGs Level - CMS Rules Change

New CMS rules for Other Medicare Required Assessments (OMRA’s) go into effect on 10/1/2011.  These rules place an additional burden on therapists to monitor when “therapy is not provided” and to adjust ARD’s (assessment reference dates) and RUG’s levels based on the level and frequency of care provided rather than on the patient’s changing condition. 

Medicare Part A Short Stay Assessments

medicare part a - short stay assessment - ssa

Knowing the Rules Can Increase Reimbursements

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